Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
J Surg Educ. 2013 Jul-Aug;70(4):528-36. doi: 10.1016/j.jsurg.2013.04.002.
Objective assessment of resident performance continues to task program directors (PDs) with a formidable challenge. This study evaluated attitudes toward the Orthopaedic In-Training Examination (OITE), compared its value between countries, assessed its value against other metrics of resident performance, and examined program and resident factors predictive of high achievement.
Survey.
Orthopedic surgery residency programs across the United States and Canada.
One hundred sixty-six PDs and 945 residents.
Eighty-eight PDs and 331 residents completed the surveys (response rates, 54% and 35%, respectively). PDs and residents in the United States assigned greater importance to the OITE than did those in Canada and reported OITE scores from the United States were significantly higher. PDs in the United States reported greater consequences for residents with poor scores than did PDs from Canada, including remediation and reprimand. Observed structured clinical examinations, internal examinations, and in-training evaluation reports were assigned greater importance by PDs and residents in Canada, but low or no importance by those in the United States. In preparation for the OITE, residents strongly favored prior OITE and American Academy of Orthopaedic Surgeons self-assessment questions, the 'AAOS Comprehensive Orthopaedic Review' textbook, the Journal of the American Academy of Orthopaedic Surgeons, and an OITE-based multiple-choice question website. Regression analysis identified resident and program emphasis on OITE studying and higher level of training as positive predictors for higher OITE scores.
The OITE is more important to PDs and residents in the United States than it is in Canada, and the reported OITE scores reflect these attitudes. PDs in Canada also employ a greater diversity of evaluative tools, a practice in keeping with recent advances toward competency-based medical education. The findings of this report may help PDs be aware of alternative methods of formative resident evaluation and ultimately improve the training of future independent surgeons.
客观评估住院医师的表现仍然是项目主任（PD）面临的艰巨挑战。本研究评估了对骨科住院医师培训考试（OITE）的态度，比较了其在不同国家的价值，评估了其与住院医师表现的其他指标的相关性，并考察了预测高成就的项目和住院医师因素。
调查。
美国和加拿大的骨科住院医师培训计划。
166 名 PD 和 945 名住院医师。
88 名 PD 和 331 名住院医师完成了调查（响应率分别为 54%和 35%）。与加拿大的 PD 和住院医师相比，美国的 PD 和住院医师认为 OITE 更为重要，并且报告的美国 OITE 得分明显更高。与来自加拿大的 PD 相比，美国的 PD 报告说，对于成绩不佳的住院医师，后果更为严重，包括补救和谴责。观察性结构临床考试、内部考试和培训期间评估报告在加拿大的 PD 和住院医师中被赋予了更高的重要性，但在美国的 PD 和住院医师中则被赋予了较低或不重要的重要性。为了准备 OITE，住院医师强烈倾向于先前的 OITE 和美国骨科医师协会自我评估问题、《美国骨科医师协会综合骨科复习》教科书、《美国骨科医师协会杂志》以及基于 OITE 的多项选择题网站。回归分析确定了住院医师和项目对 OITE 学习的重视程度以及更高的培训水平是更高 OITE 分数的积极预测因素。
OITE 对美国的 PD 和住院医师比加拿大更为重要，报告的 OITE 分数反映了这些态度。加拿大的 PD 还采用了更多样化的评估工具，这与最近朝着基于能力的医学教育的发展保持一致。本报告的结果可以帮助 PD 了解形成性住院医师评估的替代方法，并最终提高未来独立外科医生的培训水平。
